Application for
Renewal Of Registration
with the
Maharashtra Medical Council, Mumbai
Application No :
MMC202167678
Date :
28/12/2021
To,
Registrar ,
Maharashtra Medical Council ,
189/A, Anand Complex, 2nd Floor,
Sane Guruji Marg, Arthur Road Naka,
Chinchpokali (W), Mumbai - 400 011.
Sub: Dr (Smt/Shri)
KALE CHANDRASHEKHAR BHALCHANDRA
Registration No:
2002093380
Registration Date :
16/09/2002
Valid upto Date :
28/02/2027
Sir,
I the undersigned applicant, request yoy that my name may be continued on the Register of Medical Practitioners maintained by the Maharashtra Medical Council as per 23 (a)/23 (c) of MMC Act 1965 and amendment 2003. My particulars are as Follows :
Name of Applicant
:
Mr.
KALE
CHANDRASHEKHAR
BHALCHANDRA
Name of Father
:
Mr.
Name of Mother
:
Mrs.
In Case of Married Women
Maiden Name
:
-
RESEDENTIAL ADDRESS
:
11/601, MANDAR, VASANT VIHAR , POKHRAN ROAD NO 2 , THANE
City
:
THANE
District
:
THANE
State
:
MAHARASHTRA
Country
:
INDIA
Pincode
:
400610
Date of birth
:
10/03/1978
Tel No (Res)
:
Clinic No
:
Mobile No
:
9320426222
Email Id
:
drshekharkale@rediffmail.com
Total Obtained Credits Points
:
36
Remaining Credits Points
:
0
Qualification Details
Details of Qualification
Name of College
University
Passing Year
Certificate No
Certificate Date
1.
M.B.B.S.
LTMC MUMBAI
MUMBAI UNIVERSITY
2002
2.
M.S. (Ophthalmology)
K.E.M MUMBAI
MUMBAI UNIVERSITY
2007
28429
12/07/2007
Pariticulars Of Payment
Payment Mode
:
Online Payment
Receipt No
:
202136295255506
Receipt Date
:
29/12/2021
I have uploaded following documents:
1.
Latest Passport size Photograph
DECLARATION (Registered Medical Practitioner)
I shall abide by the Code of medical Ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002.
Date :
28/12/2021
Applicant signature
NOTE:- You do not need to submit the print out of original submitted Renewal Application form to MMC office.